1255546867 NPI number — MS. TRACY L TORGERSON IBCLC, RLC

Table of content: MS. TRACY L TORGERSON IBCLC, RLC (NPI 1255546867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255546867 NPI number — MS. TRACY L TORGERSON IBCLC, RLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TORGERSON
Provider First Name:
TRACY
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
IBCLC, RLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255546867
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 W GREEN MEADOWS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STREAMWOOD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60107-1130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
224-200-7031
Provider Business Mailing Address Fax Number:
312-626-2434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 W GREEN MEADOWS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STREAMWOOD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60107-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
224-200-7031
Provider Business Practice Location Address Fax Number:
312-626-2434
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174N00000X , with the licence number:  10421502 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10421502 . This is a "INTL LC CERT. NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 55380867 . This is a "STATE TAX ID NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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